Home Health & Hospice Week

Home health agencies are getting no favors from the Medicare Payment Advisory Commission's March report to Congress.

As agreed upon in its January meeting, MedPAC recommends that Congress eliminate the market basket inflation update for 2011 for home health agencies and rebase rates (see Eli's HCW, Vol. XIX, No. 4, p. 26). That would strip more than $10 billion from Medicare HHA spending over five years, the report says. MedPAC also wants prospective payment system changes to combat possible care stinting; outcome measures by patient category; and enhanced fraud-fighting measures such as moratoriums and prompt pay rule suspensions.

And the Commission resurrects an old budget standby -- a home health visit copayment.

On the hospice side: The number of hospice providers grew 47 percent from 2000 to 2008, mostly in the non-profit sector, MedPAC says in the report.

The Commission recommends that Congress reduce hospice payments by a "productivity" adjustment in 2011, which would reduce Medicare payments by up to $5 billion over five years. MedPAC also reiterates its recommendations from last year's report on drastically restructuring the hospice payment system (see Eli's HCW, XVIII, No. 4, p. 26).

The Commission's HHA recommendations severely threaten beneficiaries' access to home care,insists the National Association for Home Care & Hospice. They also "put at risk nearly one million home health care jobs while increasing health care costs," NAHC's Val Halamandaris says.

"MedPAC's recommendations for across-the-board cuts ... will hurt vulnerable home health patients who have complex health issues or are disadvantaged," says Visiting Nurse Associations of America's Andy Carter. And copays would drive underprivileged patients into institutional settings, Carter argues in a release.

"MedPAC's report contains serious data omissions, analytical prejudices, and no consideration of the value that home care brings to an ever-costlier Medicare program in terms of preventing hospitalizations and re-hospitalizations, nor its value in avoiding more costly institutional care," NAHC says.